Chapter 9 - Fluorinated Molecules in Eye Surgery: Experimental and Clinical Benefit of a Heavy Silicone Oil Oxane Hd® (Mixture of Silicone Oil and RMN3 Fluorine Olefin) in the Treatment of Retinal Detachment

Abstract

Rhegmatogenous retinal detachment (RD) is defined by fluid accumulation in the subretinal space through retinal tear, inducing separation of the neurosensory retina from the retinal pigmentary epithelium. Treatment consists in performing a retinal scar (retinopexy) around the tear and maintaining the retina in contact by gas or silicone oil tamponade. Complex, inferior dehiscence RD often recur by lesion reopening and/or by vitroretinal inflammation [vitro-retinal proliferation (VRP)] secondary to ineffective inferior internal tamponade. Indeed, silicone oil and protracted action gases, which are internal tamponades whose tolerance has been proven in vitroretinal surgery, are less effective in the internal tamponade of inferior lesions their density being lower than that of water. Supplemental actions are required to improve inferior internal tamponade, such as the fitting of inferior episcleral indentation or inferior retinectomy, often combined with intensive positioning of patients in strict ventral decubitus, facing ground or even sometimes in declive posture so as to achieve better tamponade of the inferior part. The purpose of this chapter is to summarize some experimental results concerning Oxane Hd®, especially clinical results obtained before the commercialisation of Oxane Hd®. It does not pose any emulsification or major fragmentation problem, as encountered with other “heavier than water” products. Its effectiveness on inferior and posterior dehiscence tamponade appears to be very effective to currently available anatomical results. Oxane Hd®, moreover, presents in this context a real benefit in the treatment of complex retinal detachment. Retinopexy quality and the absence of residual subretinal fluid in internal tamponade of inferior lesions, extensive inferior retinectomies in particular, may reduce the risk of recurrence of complex retinal detachment by PVR.